Patient Escorts: An Essential Element of an HIV Program In Nigeria

Oniyire Adetiloye

Overview
Context Intervention: Patient Escort Program Method of assessment Lessons learned Next steps/Recommendations

Context
ZAIHAP project Basic HIV statistics from Nigeria and project state Very few ART service points found across project state Very weak referral system found across Nigeria: Baseline Analysis Report indicated 20% of referred clients made it to referral sites; of those who arrived, only 42% returned to the primary referring facility

Nigeria

1 2 3 4

Population Nigeria/Zamfara HIV prevalence Retention in care % of identified HIV-positive pregnant women served with ARVs in 2012 PMTCT coverage as of 2012 Number of ART clinics in the project state as of 2011

168M/4M 4.1/2.1 < 60% < 62%

5 6

22% 3

Intervention: Patient Escorts as a Component of Referral System

Objective was to reduce loss to follow-up: assumption that escorts would improve the twoway referral system by ensuring clients get to where they are being referred and provide feedback to the referring sites Training, support and incentives provided to community volunteers (PLHIV) 80% and care providers 20% to act as patient escorts

Intervention Continues
Volunteer program then integrated into other existing community health and social support programs with the assistance of community leaders Each community became responsible for management of the volunteer system
Bikes on standby at the request of escort team

Method of Assessment
Retrospective analysis of data from 6 of 31 sites Data collated from four different periods: at baseline 6, 12 and 18 months after the introduction of the escort service Analysis focused on differences in uptake and quality of referral services over 2-year period

Results (Cohorts of clients reviewing the registers)

Indicator Baseline 6 Months Post Intervention 93% 226 of 244 12 Months PostIntervention 70% 240 of 343 18 Months PostIntervention 98% 398 of 406 Significance

% of clients successfully referred (got to the referred destination) % of clients successfully counter-referred (subset of above)

19% 17 of 89

*p <.001

42% 7 of 17

96% 217 of 226

68% 163 of 240

97% 386 of 398

*p <.001

Results
120 100 80 60
42% 93% 96% 95% 97% 70% 68%

% of clients who succesfully got to where they were referred % of clients who returned to provide feedback to the primary sites after accessing care

40
20 0 At Baseline 6 months after 12 months 18 months after after
19%

10

Lessons Learned
The escort system improves feedback to the primary referral site Community ownership and involvement improve referrals and retention in care: Increase in successful referral between 12 and 18 months attributed to community leader involvement Community-led patient escort program is a valuable addition to HIV care and treatment continuum of care

Next Steps/Recommendations
Consider patient escort to improve retention rate in other settings, e.g., PMTCT, TB and ART services and many more This initiative should be scaled up to other HIV programs across Nigeria and other countries with problems of loss to follow-up Further research should be considered to explore reasons why the system is so successful to further understand and expand upon effective interventions

There is no universal solution, but there is a universal process to find appropriate local solutions -Carl Taylor

Thank you
This project was made possible with support from President's Emergency Plan for AIDS Relief through the The United States Department of Health and Human Services/Centers for Disease Control and Prevention (CDC), Division of Global HIV/AIDS, under Cooperative Agreement #5U2GPS001067-05. The findings and conclusions in this abstract are those of the author(s) and do not necessarily represent the official position of the CDC.